In a hospital in Ethiopia’s capital, Addis Ababa, in mid-May, Tewodros* was at work treating patients when two police officers barged into the emergency room. Earlier that same month, the doctor had participated in a public sector health workers’ strike, protesting poor working conditions and low pay.
The government had immediately declared the strike illegal, setting the stage for a tense standoff with the country’s health professionals. The emergency room where Tewodros was working was one of the places where that played out.
The officers said they were taking him in for questioning but gave no reason, Tewodros says. They grabbed him and pulled him out of the ward. His colleagues tried to intervene, but the police ignored them and took him to a nearby station, where he was held for more than three weeks.
“That was the moment I felt helpless. That was the moment I was ashamed of my country,” Tewodros told Al Jazeera, recounting the incident.
His detention was only the beginning of his ordeal. He says he was crammed into a cell with 15 other people. They weren’t permitted to wash, and he never got to see or speak with his family. Al Jazeera reached out to Ethiopia’s police for a response to the accusations, but they did not reply.
The strike was led by the Ethiopian Health Professionals Movement (EHPM), a loose collective of doctors that had formed in 2019. On May 19, they issued a 12-point list of demands to the government, including requests for fair salaries, health insurance, transport support and improved workplace conditions. When the deadline passed with no meaningful engagement from authorities, hundreds of doctors began walking out of hospitals across the country.
The Ethiopian government adopted “repressive tactics” against the striking doctors, according to rights groups, arresting 47 people throughout Ethiopia within a few days, and dozens more over the following weeks.
Tewodros was one of more than 140 doctors arrested in a sweeping crackdown in May and June, according to the EHPM. They launched a website, Health Voice Ethiopia, to track their arrested colleagues, how long they were detained for, and when they were released.
All the doctors have since been released, and the strikes have ended following a government promise to address their concerns, though no concrete commitments have been made, the doctors say.
“The government should stop harassing and jailing healthcare workers and their representatives and finally engage with them in a meaningful dialogue about their complaints,” Laetitia Bader, the Horn of Africa director at Human Rights Watch, told Al Jazeera.
Ethiopia’s federal police said the detained doctors had organised an “illegal strike” and accused them of endangering patients’ lives.
Paid $60 a month
Ethiopia’s doctors are among the lowest-paid in East Africa, according to World Bank figures, with some earning as little as $60 a month, compared with neighbouring Kenya, where doctors expect to be paid closer to $1,800.
One Ethiopian pathologist, who spent time working in Hargeisa, the capital of the self-declared republic of Somaliland, told the BBC her $2,500 monthly salary there was enough to cover that of 20 of her colleagues back home. She was later arrested.
Doctors have reported difficulties paying rent, eating, covering transport costs and an inability to afford healthcare for themselves.
Al Jazeera interviewed half a dozen doctors – some of whom were arrested for participating in the strike – who cited biting inflation, stagnant wages and extremely difficult working conditions as having pushed them to take industrial action.
One doctor said he spends well more than two-thirds of his $73 monthly salary on rent, and turns to what he called “side hustles”, such as content creation for local businesses. Other doctors, he added, work at pharmacies and even as Uber drivers to make it through the month.
“I am not really able to take care of myself, let alone think about a family,” he said. “I struggle to travel to work, it is hard to eat, and being a doctor isn’t a job that leaves much time. We have to work extremely hard just to get by. We had higher expectations.”
Prime Minister Abiy Ahmed said in June that his government was aware doctors are “being crushed by life”, an acknowledgement of their difficulties. But he accused those striking of being “political opportunists” and “politicians in white coats”.
Ethiopia has faced soaring inflation since floating its currency last year, sharply eroding the value of wages as consumer prices in the capital have surged. Ethiopia’s currency, the birr, hit an all-time low of 174 to the US dollar in black markets in July, a sign that despite reassurance from the central bank that inflation would subside, the economy remains fragile.
The country is also still recovering from the combined impacts of COVID-19 and a devastating two-year war in the northern Tigray region, which, according to one report, is expected to result in cumulative losses of nearly $125bn to Ethiopia’s economy by 2027.
These overlapping crises have placed immense strain on Ethiopia’s already fragile public services, and the health sector is among the hardest hit.
30-hour shifts; fixed salaries
For the country’s doctors, whose salaries are fixed and paid in birr, the effects of inflation and currency depreciation have been particularly severe, and many find themselves unable to meet even their most basic needs.
When they arrive at work, they often face long, gruelling shifts as long as 30 hours in some cases, are understaffed, and lack the equipment needed to carry out their duties.
The roots of the issues in Ethiopia’s healthcare system go back to its attempt to address an earlier shortage of qualified doctors. In 2003, Ethiopia had 0.26 physicians per 10,000 people, lower than Kenya, which had 1.38 doctors per 10,000 and Eritrea which had 0.42.
The government was then led by Meles Zenawi, once a medical student himself, who announced it would begin working towards the goal of universal healthcare coverage, through the expansion of health insurance, but also access to doctors.
The government adopted a “flooding policy” to address the shortage, rapidly increasing enrolment in medical courses and expanding the number of medical schools in the country.
According to World Health Organization (WHO) figures, the policy succeeded, increasing the number of doctors in the country by 851 percent in just a decade, from an estimated 1,936 to 18,413.
Yet, despite the significant increase in the number of doctors during those years, successive governments have been unable to raise doctors’ salaries to competitive levels, in a country that already ranks among Africa’s lowest in gross domestic product per capita. Coupled with a health sector heavily reliant on aid and a period of high inflation, the real value of doctors’ salaries has been steadily eroded.
Mulugeta Gebrehiwot, an Ethiopia researcher at the World Peace Foundation, said the government has shifted its focus to “vanity infrastructure projects”, such as reshaping the capital’s skyline, abandoning the development ethos of earlier administrations. “They’re more focused on the way things look,” he told Al Jazeera.
Truck drivers can earn more
“This was the only way to make our voices heard,” Tewodros said about the strikes. He said he is now seriously considering leaving the medical profession for better-paid jobs in the country’s service sector.
“One of my relatives is employed as a truck driver and earns about $250 per month, which is more than three times my salary as a medical doctor.”
Dagwami Mulugeta is a doctor who left Ethiopia during the sweeping arrests in May; he has since settled in the United States. He left shortly after two friends of his were arrested and his Facebook profile was hacked, fearing he would be next due to his role in organising and supporting the strike.
“We have to make such a huge sacrifice, and at the end we’re not paid fairly and have to struggle to cover basic costs,” he said, telling Al Jazeera he and many of his colleagues feel unrewarded for the time they have dedicated to the profession.
Many doctors leave the country, and those who do not go abroad leave the job, he added.
In 2019, when he entered the profession, he said doctors had to work 36-hour shifts with little to no sleep, and had to treat patients with outdated equipment, if what they needed was available. This triggered strikes back then, which helped reduce their hours to 30 per week in most government hospitals, but without significant changes to their salaries.
“There were some improvements,” says Dagwami, “but overall the conditions for doctors didn’t improve enough.”
Lulit* is a doctor who left medicine for humanitarian work. “There was more hope back then,” she said of the 2019 strikes she participated in. She said many doctors had expected Prime Minister Abiy – who had branded himself as a reformist at the time – to meet their demands. “There was a compromise, but doctors were left disappointed and their problems built up,” she said.
The most prominent doctor arrested in the strikes was Daniel Fentaneh, a resident in gynaecology and obstetrics and a lecturer at Bahir Dar University in northwest Ethiopia, who was detained at the end of June and is regarded by some of his colleagues as a Che Guevara-like figure.
He played a key role in rallying his colleagues during the strikes and was charged with “inciting, mobilising, and organising”.
Rights groups like Amnesty International called for his “unconditional release”, which followed 27 days later. But his detention was a major blow to the morale of his fellow doctors, and the EHPM said his arrest was a “shameful betrayal of justice and conscience”.
‘We don’t want to leave our jobs’
A 2020 study by a group of Ethiopian academics found that just more than half of Ethiopian doctors were satisfied with their jobs, while only 6.8 percent of those surveyed said they were satisfied with their income. Another study conducted in 2022 found that approximately six out of 10 doctors in the country were considering leaving their jobs.
Ethiopia allocated 8.3 percent of its budget to healthcare in 2023 and 2024, an increase from the previous year. However, the UN children’s fund UNICEF notes that due to higher inflation and a weaker birr, the real value of this allocation has declined. It also remains well below the 15 percent target set by the 2001 Abuja Declaration, in which African Union countries pledged to allocate that share of their national budgets to health.
This compounds challenges related to recruitment and retention of staff.
Ethiopia was lauded for the dramatic expansion of its healthcare system in the early 2000s, led by then health minister Tedros Adhanom Ghebreyesus, who later became director-general of the WHO. Between 2000 and 2019, the share of facility births rose from 5 percent to 48 percent, full childhood vaccination coverage tripled, and between 1990 and 2013, maternal deaths per 100,000 live births dropped from 1,400 to 420.
But for a new generation of medical professionals, the legacy of that progress sits uneasily alongside new realities. Dagwami, who recently completed his training, says he knows of many doctors who have left the field for more lucrative sectors, from social media management to founding their own companies.
“Doctors are passionate about their work,” he said, “and we don’t want to leave our jobs. But these working conditions make life hard for us and endanger patients. It isn’t good for anybody.”
In late June, Abiy held a meeting with a selected group of health workers, attempting to strike an uneasy balance between acknowledging their “valid concerns” about salaries with launching verbal attacks on those who took industrial action. The prime minister said the striking doctors do not understand what it means to provide a service or how to build a nation. “These are people who reduce everything, from science museums to high schools, to salaries,” he said.
Dagwami said “witnessing the condescension, public belittling, and imprisonment of dedicated professionals was one of the most heartwrenching and unparalleled experiences of my life.”
Doctors tried to be “constructive” and “solutions-oriented”, but the government did not rise to the occasion, he feels.
Al Jazeera reached out to the government in Addis Ababa for a response, but received no reply.
The doctors are currently waiting for the government to deliver its response to a commitment it made to address the issues they have raised. But on the Health Voice website – that was set up to track the arrests and release of their colleagues – a clock steadily ticks down.
If their concerns are not addressed before time runs out, they have pledged to go back on strike.
*Some names have been changed at the doctors’ requests, out of concern that speaking out could lead to arrest.
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